1346263209 NPI number — GULF BIOMECHANICAL LABORATORY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346263209 NPI number — GULF BIOMECHANICAL LABORATORY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GULF BIOMECHANICAL LABORATORY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346263209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4045 E SOUTHCROSS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78222-3636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-495-3999
Provider Business Mailing Address Fax Number:
210-495-3393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 CRAWFORD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-739-1911
Provider Business Practice Location Address Fax Number:
713-793-7588
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
210-495-3399

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 101035 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 156086402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 530204 . This is a "BLUE CROSS DME" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 530754 . This is a "BLUE CROSS O & P" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 156086401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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